As whooping cough killed thousands of kids annually, a trio of public health workers were deeply involved in the production and distribution of a vaccine.
As published online by digital library JSTOR, a century ago, pertussis, better known as whooping cough, struck about 100,000 children a year in the United States. It killed about 6,000 annually during the 1920s.
According to the Nigeria Centre for Disease Control, pertussis is highly contagious and can spread from person-to-person through contact with respiratory droplet, or by contact with airborne droplets of respiratory secretions.
Pertussis illness is often described in two stages based on the symptoms and when coughing starts:
Early symptoms (first 1-2 weeks) — mainly ‘cold’ symptoms
- Mild cough
- Runny nose
- Fever (low grade and not seen in all people)
- Infants may have “apnea” which is a pause in breathing
Later symptoms (between 2-12 weeks)
- Rapid coughing fits (bursts of repeated uncontrollable cough also called coughing spells or paroxysms) often followed by a loud high pitch “whooping” sound on breathing in.
- Vomiting—throwing up usually after a coughing fit.
- Tired feeling after coughing fits and poor sleep.
- Pertussis infection increases a person’s risk of developing pneumonia. A person who is getting better from whooping cough may be more at risk of getting another infection.
- Rarely, infants can have seizures or irritation of the brain.
- People can have low oxygen levels or pass out during coughing spells. Some can get rib fractures (cracked ribs) due to the force of coughing. The cough can last for 6-10 weeks. It has been called the “100-day cough.” How long a person is ill depends on age, other health conditions, and whether antibiotic treatment is given in the early stage of illness. As a person recovers, coughing fits become less frequent and severe.
A deadly bacterial disease
A bacterial disease, it was deadlier than other once-common scourges of childhood, including diphtheria, scarlet fever, measles, and tuberculosis. Historian Carolyn G. Shapiro-Shapin describes how a vaccine for pertussis was developed and tested in Grand Rapids, Michigan, a city that had a devastating outbreak in 1932, by public health professionals working in partnership with the community. The leaders of this effort were women.
In the “trying economic times” of the Great Depression, Shapiro-Shapin writes, Pearl Kendrick and Grace Eldering “motivated the health-conscious Grand Rapids community not only to adopt extant vaccines, but also to actively sponsor and participate in innovative public health research.”
Kendrick and Eldering were the beneficiaries of the Progressive Era’s expansion of scientific education to women and institutional public health employment. (Both would earn doctorates after their work on the pertussis vaccine.) Kendrick was put in charge of the Western Michigan Branch of the State Laboratory in 1926. She hired Grace Eldering in 1932. Eldering would take the helm from Kendrick in 1951.
Kendrick also hired Loney Clinton Gordon, trained as a dietician, to culture a strain of pertussis with sufficient virulence to make a vaccine. Which she did. Before being hired by the State Laboratory, Gordon hadn’t been able to find a position as a dietician: She was told white people wouldn’t take dietary advice from a Black woman.
Michigan was one of a handful of states with a strong public health programme before World War II. That had real benefits: The Michigan Department of Health “was remarkably successful in lowering the death rate in the state in the years from 1920 to 1940.” Shapiro-Shapin attributes this to “decentralising care; improving education and outreach; adopting, incorporating, and extending federal priorities and programs into the state’s extant channels; and, most importantly for the pertussis programme, making a commitment to pursue cutting-edge research.” The success of a diphtheria-prevention campaign in the 1920s set the precedent with testing, education, and vaccines available to all, regardless of income.
The PTA, Chamber of Commerce, and Visiting Nurses Association all supported the city and state health bureaucracy in the effort to find an “effective, safe, inexpensive, and easily produced pertussis vaccine.” Dozens of local physicians provided diagnostic “cough plates” from patients. Outreach efforts extended into local counties and enrolled the Depression era’s welfare commissions and administrations, funded with state and federal monies. The economic crisis meant many families receiving aid were visited by city medical professionals, key to monitoring disease spread.
The field trial between 1934 and 1936 had excellent results but was challenged by skeptics. “As a matter of mere probability the odds are strongly against Miss Kendrick’s experiment being sound,” wrote a Johns Hopkins epidemiologist who was ultimately “unable to find the faults he expected,” Shapiro-Shapin writes.
The Biological Products Division, part of Michigan’s state health department, was producing enough vaccine to distribute it nationally by 1940. The results were very good: The death rate for whooping cough dropped from 5.9 per 100,000 in 1934 to fewer than one per 100,000 in 1948.
Although whooping cough can still be deadly, with over 160,000 people around the world dying of it every year, Kendrick, Eldering, and Gordon helped lay the groundwork for the remarkable success of the pertussis vaccine.
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